The word “Trauma” originally referred to serious physical wounds that resulted from violence or accidents. This sense of the word is still used sometimes. For example, if someone has a brain injury resulting from a motorcycle accident, you might hear it referred to as ‘brain trauma’.
In the 20th century psychologists began to realize that the term trauma could be used to describe psychological ill-health as well – especially when it had resulted from shocking or violent events. They began to study the effects of warfare on the human behavior and the way it effected the men who were on the front line of conflict for long time periods.
The term ‘shell-shock’ was first coined in World War 1 and is probably familiar to most people. This concept described men who had ‘lost their senses’ (become dissociated and delusional) due to intense enemy shelling or other forms of violent and prolonged bombardment.
By the 1970’s, after an intensive study of the effects of war in Vietnam veterans, the term PTSD (Post-traumatic stress disorder) entered the medical mainstream and has been used ever since by medical bodies to describe clusters of symptoms that often result from exposure to traumatic events such as prolonged battle.1 Those symptoms include:
- Feeling emotionally numb
- Losing interest in activities that were enjoyable in the past
- Amnesia regarding the traumatic event.
- Hyper vigilance to threats (seeing threats that aren’t there)
- Jumpiness, or an exaggerated startle response,
- Sleep disturbance (insomnia) – this might include problems of falling asleep, staying asleep, and restless sleep.
- Irritability and/or aggressive behaviour – frequent, irritable or aggressive behaviours that occur with little or no provocation.
- Problems with concentration – this is often confused with ADD (attention deficit disorder)
- Reckless or self-destructive behaviours
Slowly, it came to be understood that it was not just battlefield experiences which could lead to these symptoms, but also other life-threatening experiences, such as;
- Serious sexual assault and rape
- Extreme violence or being attacked by an animal
- Vehicle accidents
- Natural disasters
- Botched surgeries
- Witnessing such things in other people
Such events can cause individuals to enter a state of post-traumatic stress which persists over the long term. This might be diagnosed as PTSD, or it might not. Not all traumatic stress meets the strict criteria of PTSD, but that doesn’t mean that it’s not ‘trauma’.
A very broad definition of trauma might be as follows:
“Any event which overwhelms an individual’s ability to cope, and which creates ongoing consequences for the individual’s mental and emotional health as well as their social functioning”.
So we should understand that when we use the word ‘trauma’, we are not necessarily talking about PTSD. Counseling psychologists often refer to this type of trauma (non PTSD trauma) as ‘small t’ trauma.
Small ‘t’ Trauma
Small ‘t’ trauma can best be described as fairly common life events that are experienced as upsetting, hurtful, or damaging. (In other words, they are adversities.) Much of the abuse, neglect or abandonment that we studied in module 4 on Adverse Childhood Experiences would fit into this small ‘t’ trauma category.
These events may not be as significant as shock trauma (which causes PTSD) but the emotional impact to the individual is still significant. Below are some examples
- Being bullied over a long time period (especially in early years)
- Being abandoned suddenly by a partner
- Divorce of parents in early years (3-12)
- Extreme poverty
- Changing schools frequently as a child and not fitting in
- Sudden unemployment or curtailment of career
- Being physically threatened on a regular basis
Complex trauma refers to trauma that comes from dwelling in an adverse environment over an extended time period. It is also sometimes referred to as “inescapable stress”. Over time the accumulative effect of this inescapable stress can be ‘traumatizing’ in the general sense of the word. Complex trauma results from its repetition, its prolonged nature, and its accumulation over time. Examples of this type of trauma would be multiple military deployments, long term domestic abuse, or even growing up in a very impoverished home or neighborhood.
Developmental & Relational Trauma
Relational Trauma refers to a type of complex trauma that most commonly develops within the context of relationships, usually the family of origin (your parents’ household) or the nuclear family (you and your partner’s household). An example of this might be growing up with a single parent who is mentally unwell.
Developmental trauma refers to complex trauma that develops during key stages of psychological growth in childhood and adolescence. As we saw in module 4, certain key lessons should be getting learned during those stages such as;
- The world is a safe place and there are people I can trust (0-2)
- I am able to exert my influence on my environment (2-4)
- My imagination is a superpower (5-8)
- I am competent because I have mastered certain skills/hobbies/sports and have been praised for it (9-12)
- I fit in and belong (12-18)
Sometimes problems at home or school (such as abuse, neglect or abandonment by parents or others) interferes with this process. In this case, healthy traits that should be developed in these stages (such as trust) are missing, and we end up as adults who are stuck in former stages of development or who have unresolved issues from former stages of development. We then invariably find dysfunctional coping mechanisms to deal with these developmental challenges (e.g. drug abuse).